Wada Shinichi, Inoue Manabu, Matsuki Takayuki, Okata Takuya, Kumamoto Masaya, Tagawa Naoki, Yoshimura Sohei, Okamoto Akira, Miyata Toshiyuki, Ihara Masafumi, Toyoda Kazunori, Koga Masatoshi
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
J Neurol Sci. 2020 Apr 15;411:116704. doi: 10.1016/j.jns.2020.116704. Epub 2020 Jan 22.
The aim of this study was to evaluate the anticoagulation intensity of dabigatran for acute ischemic stroke patients and hemorrhagic/ischemic events after early initiation of dabigatran.
Acute ischemic stroke/transient ischemic attack (TIA) patients admitted to our hospital who started dabigatran from January 2012 to December 2017 were studied. Blood samples were drawn just before (0 h) and 4 h after dabigatran at a median of 5 days after starting dabigatran to measure dabigatran concentrations (C, C) based on the thrombin clotting time assay (Hemoclot®).
Of the 70 patients (54 men, 69 ± 9 y), 14 started dabigatran after a TIA, and 56 started it after an ischemic stroke a median of 5 days after onset. C, C was 82.5 ± 58.0, 143.1 ± 98.2 ng/dl (150 mg BID, 35 patients) and 50.6 ± 40.9, 91.2 ± 64.7 ng/ml (110 mg BID, 35 patients). During a median follow-up of 382 (IQR 109-688) days of all 70 patients, five had clinical events. Three patients had bleeding events, two with nasal bleeding (C, C: 50, 80 ng/ml, C, C: 91, 173 ng/ml) and one with GI bleeding (C, C: 5, 5 ng/ml). Two patients had ischemic events, one with ischemic stroke (C, C: 10, 50 ng/ml) and another with acute myocardial infarction (C, C: 40, 40 ng/ml).
There was no obvious relationship between dabigatran concentration and hemorrhagic/ischemic events in this study. Larger sample study will be needed to examine the relationship between the concentration and events in clinical practice.
本研究旨在评估达比加群对急性缺血性脑卒中患者的抗凝强度，以及早期应用达比加群后的出血/缺血事件。
对2012年1月至2017年12月在我院住院并开始使用达比加群的急性缺血性脑卒中/短暂性脑缺血发作（TIA）患者进行研究。在开始使用达比加群后中位数5天，于用药前（0小时）和用药后4小时采集血样，采用凝血酶凝血时间测定法（Hemoclot®）测定达比加群浓度（C0、C4）。
70例患者（54例男性，年龄69±9岁）中，14例在TIA后开始使用达比加群，56例在缺血性脑卒中发病后中位数5天开始使用。150mg每日两次组（35例患者）的C0、C4分别为82.5±58.0、143.1±98.2ng/dl，110mg每日两次组（35例患者）分别为50.6±40.9、91.2±64.7ng/ml。在全部70例患者中位数382天（四分位间距109 - 688天）的随访期间，5例发生临床事件。3例发生出血事件，2例鼻出血（C0、C4：50、80ng/ml，C0、C4：91、173ng/ml），1例胃肠道出血（C0、C4：5、5ng/ml）。2例发生缺血事件，1例缺血性脑卒中（C0、C4：10、50ng/ml），另1例急性心肌梗死（C0、C4：40、40ng/ml）。
本研究中达比加群浓度与出血/缺血事件之间无明显关系。需要更大样本的研究来检验临床实践中浓度与事件之间的关系。
